Abstract
Studies have reported controversial findings on the association between fetal growth restriction (FGR) or intertwin weight discordance and the risk of hypertensive disorders of pregnancy (HDP) in twin pregnancies. The aim of this study was to investigate the association between twin growth disorders and HDP. Twin pregnancies resulting in two live births at St George’s Hospital between 2000 and 2019 were included. FGR or small-for-gestational-age (SGA) at birth was assessed using singleton and twin reference charts. Intertwin discordance [(large birthweight − small birthweight)/(large birthweight) × 100%)] was calculated. Logistic regression models were performed. SGA (aOR 2.34, 95% CI 1.60–3.44, p < 0.001), intertwin discordance ≥25% (aOR 2.10, 95% CI 1.26–3.49, p = 0.004) and their co-existence (aOR 2.03, 95% CI 1.16–3.54, p = 0.013) were significantly associated with HDP. After adjusting for the known maternal risk factors of HDP and the intertwin discordance, SGA (using the twin charts) was the strongest independent risk factor associated with HDP (aOR 2.12, 95% CI 1.40–3.22, p < 0.001) and preeclampsia (aOR 2.34, 95% CI 1.45–3.76, p < 0.001). This study highlights that the presence of at least one SGA twin is significantly associated with HDP during pregnancy. Therefore, maternal blood pressure should be closely monitored in twin pregnancies complicated by SGA with or without intertwin discordance.
Highlights
The rising age at childbirth and the extensive use of fertility enhancing treatments have contributed to the increased incidence of twin pregnancies [1]
Whereas the association between fetal growth anomalies and hypertensive disorders of pregnancies (HDP) has been well established in singleton pregnancies [7], several studies investigating this relationship in twin pregnancies have reported conflicting results [8,9,10,11,12,13]
When compared to normotensive twin pregnancies, those complicated by HDP delivered at a significantly earlier gestation (median (IQR) 36.1 (34.6–37.1) weeks vs. 36.9 (35.0–37.6) weeks, p < 0.001), were more likely to be admitted to the High Dependency Unit (HDU) or Intensive Care Unit (ICU) (19.1% vs. 4.4%, p < 0.001), and their babies more likely to be admitted to the neonatal unit (NNU) (38.8% vs. 30.7%, p = 0.040)
Summary
The rising age at childbirth and the extensive use of fertility enhancing treatments have contributed to the increased incidence of twin pregnancies [1]. Many pregnancy complications are more commonly encountered in multiple pregnancies than in singletons, including hypertensive disorders of pregnancies (HDP), the incidence of which is at least two times higher, in both dichorionic and monochorionic twin pregnancies [2,3]. A common fetal complication of twin pregnancies is small for gestational age (SGA), defined as birthweight
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
